Evaluation of a peritoneal surface disease severity score in patients with colon cancer with peritoneal carcinomatosis.
BACKGROUND
Systemic therapy and cytoreduction (CRS) with hyperthermic intra-peritoneal chemotherapy (HIPEC) may benefit selected patients with carcinomatosis from colon cancer (PC). This study presents the results of a consecutive series of patients evaluated under a single strategy.


METHODS
Forty patients with PC referred for CRS were evaluated. Evaluation of their treatment was determined according to disease severity scored on a 3-point scale including: (1) symptoms, (2) extent of peritoneal dissemination (PCI), and (3) primary tumor histology. Overall survival (OS) was analyzed using Kaplan-Meier product-limit method and log rank testing according to four tiers of estimated disease severity based on the above parameters.


RESULTS
For patients with disease severity score I, II, III, and IV, 2-year OS following treatment was 100%, 80%, 80%, and 0%, respectively. Median OS with most advanced disease (IV: n = 20) was 5 months versus 36 months for disease of lesser severity (I-III: n = 20; P < 0.001; RR = 0.2; 95%CI 0.1-0.5). Advanced disease (IV) was an independent predictor of adverse outcome on multivariate analysis with 2.6-fold increased likelihood of mortality.


CONCLUSIONS
A treatment strategy based on disease severity determined at time of diagnosis, stratifies patients into prognostic groups and may improve selection of patients for appropriate therapy.
Pelz
Joerg O W
JO
Department of Surgery, Friedrich-Alexander-University, Erlangen, Germany.
Stojadinovic
Alexander
A
Nissan
Aviram
A
Hohenberger
Werner
W
Esquivel
Jesus
J
D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003110:Colonic Neoplasms / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000473:pathology* / Q000556:secondary / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index